Provider First Line Business Practice Location Address:
34590 COUNTY LINE RD STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCAIPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92399-5398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-795-5788
Provider Business Practice Location Address Fax Number:
909-795-9243
Provider Enumeration Date:
07/24/2007